Editor's Note: This article is part of a series in partnership with the All of Us Research Program, which collects and studies health data to help scientists identify health trends. More than 80% of participants are from groups that have been historically underrepresented in research.
Chronic diseases such as cancer, diabetes, asthma, and heart disease are among the top health problems in the U.S., but all Americans don't share this burden equally. Minorities, including Black, Hispanic, and Native American people, are up to two times more likely than white people to have major long-term conditions.
Where you live and work has an impact on chronic disease rates. Things like access to education and health care, social and community support, and availability of fresh food and clean water play a role.
"They call that whole bucket of stuff the social determinants of health," says Jaya Aysola, MD, MPH. She's the executive director of the Penn Medicine Center for Health Equity Advancement. "These are the predominant set of factors that cause differences in chronic diseases."
Systemic Barriers
The reasons chronic disease rates are higher among minority groups are varied and complex, but one thing they're not is biological, says Natalia Linos, ScD, executive director of the FXB Center for Health and Human Rights at Harvard University.
"It's really important to make that distinction," she says. "We have no evidence that certain groups are biologically inclined to have more chronic disease. But what we do see are patterns by race and ethnicity."
Aysola says that people tend to view higher chronic disease rates among minorities as a product of "unfortunate circumstances," but in truth, the root causes go much deeper than that.
"Systemic historical and political and social insults have set the stage for certain communities to live in impoverished areas, to not have equal access to education, health care, or equal employment," she says. "And this is coupled with housing segregation policies … that have not let Black individuals come into certain communities."
One group that is trying to break barriers and increase diversity in medical research is the All of Us Research Program. More than 80% of program participants are from communities underrepresented in biomedical research and more than 50% are from racial and ethnic minority groups.
Poverty and Chronic Disease
According to the U.S. Office of Disease Prevention and Health Promotion, a higher percentage of minority groups live in poverty in the U.S. than white people. People with low incomes have a shorter lifespan and worse health outcomes due to a number of reasons, including:
- Poor nutrition because of lack of access to fresh foods
- Contact with toxins, such as lead
- Higher levels of stress
Poor Americans are also less likely to have the time or transportation to get to doctor's appointments and to have health insurance coverage.
"Even if you're able to show up to the doctor, you don't often know if your bill is going to be a thousand dollars or ten thousand dollars," Linos says. "And that creates an incentive for people not to do as much preventative care or come for checkups."
By skipping regular visits for a long-term condition, you raise your chances of having it turn into advanced disease. Many people also end up going to the emergency room for care. These visits are often more expensive and lead to less personalized care than a primary care provider could give you.
Environmental Issues
Communities of color have higher rates of air pollution in their neighborhoods. This not only raises their odds of getting chronic disease, it also means they'll likely fare worse if they have one.
Breathing polluted air over long periods raises your odds of getting chronic obstructive pulmonary disease (COPD), asthma, and lung cancer. Black people are 42% more likely to have asthma than white people. People of Puerto Rican descent have the highest rate of asthma out of all races and ethnic groups.
"We have to recognize that there are factors outside of individual control that shape chronic disease risks and outcomes," Linos says. "Housing conditions, labor issues, environmental concerns -- they're not distributed equally among all communities."
Public Health Messaging
The medical community uses public health campaigns to raise awareness of certain chronic conditions and promote healthy habits to help prevent disease. Although this kind of guidance is important, Linos says these efforts can be too simplistic. They may focus on creating healthy habits that are often out of reach for some members of minority groups.
"Public health information is often presented as if everybody can prevent chronic conditions just by lowering their stress, getting enough sleep, and eating whole foods," she says. "But a lot of that is outside the control of the individual. There are larger issues at play that create huge disadvantages that prevent people from living healthy lives."
What's more, racism and discrimination cause stress that leads to health problems such as:
- High rates of diabetes and high blood pressure in African American, Native Hawaiian, and Latin American people.
- More mental health disorders among Asian American and African American people.
"We need to reframe the conversation," Aysola says. "Instead of saying, 'What is wrong with this population?' we need to be asking, 'What is wrong with our social structures and within our health care system that allows this to occur and persist in this way?"
